Objective To investigate the clinical characteristics and drug resistance in elderly patients with hepatobiliary disease and bloodstream infections caused by Escherichia coli,and to provide a basis for clinical therapy.Methods A retrospective analysis was performed on the clinical characteristics and drug susceptibility of 57 elderly inpatients with hepatobiliary disease and bloodstream infections caused by Escherichia coli in our hospital from 2009 to 2012.Comparison of continuous data between the two groups was made by t test,and comparison of categorical data was made by chi-square test.Results The majority of patients had liver cirrhosis,and spontaneous bacterial peritonitis was the major infection source.A total of 57 strains of Escherichia coli were isolated from elderly patients with hepatobiliary disease,and 24(42.1%) out of them were positive for extended-spectrum β-lactamase(ESBL).ESBL-positive strains had a significantly higher level of drug resistance than ESBL-negative strains(P < 0.05),except for imipenem / cilastatin,meropenem,cefoperazone / sulbactum,ticarcillin / clavulanate,and minocycline.However,there were no significant differences in age,gender,basic disease,infection source,peak body temperature,white blood cell count,and the percentage of neutrophils between the ESBL-positive group and the ESBL-negative group(P > 0.05).The case-fatality rate in patients with septic shock,hepatic encephalopathy,or acute kidney injury was significantly higher than that in patients with no complications(χ2= 9.541,7.622,9.733,respectively,P < 0.05).Conclusion Elderly patients with hepatobiliary disease and bloodstream infections caused by ESBL-positive Escherichia coli had a high level of drug resistance and a poor prognosis for severe complications.Antibiotic therapy combined with prevention and control of severe complications should be taken as early as possible to reduce the case-fatality rate.